Propranolol for migraine prophylaxis

 

Abstract

Background

Propranolol is one of the most commonly prescribed drugs for migraine prophylaxis.

Objectives

We aimed to determine whether there is evidence that propranolol is more effective than placebo and as effective as other drugs for the interval (prophylactic) treatment of patients with migraine.

Search methods

Potentially eligible studies were identified by searching MEDLINE/PubMed (1966 to May 2003) and the Cochrane Central Register of Controlled Trials (Issue 2, 2003), and by screening bibliographies of reviews and identified articles.

Selection criteria

We included randomised and quasi-randomised clinical trials of at least 4 weeks duration comparing clinical effects of propranolol with placebo or another drug in adult migraine sufferers.

Data collection and analysis

Two reviewers extracted information on patients, methods, interventions, outcomes measured, and results using a pre-tested form. Study quality was assessed using two checklists (Jadad scale and Delphi list). Due to the heterogeneity of outcome measures and insufficient reporting of the data, only selective quantitative meta-analyses were performed. As far as possible, effect size estimates were calculated for single trials. In addition, results were summarised descriptively and by a vote count among the reviewers.

Main results

A total of 58 trials with 5072 participants met the inclusion criteria. The 58 selected trials included 26 comparisons with placebo and 47 comparisons with other drugs. The methodological quality of the majority of trials was unsatisfactory. The principal shortcomings were high dropout rates and insufficient reporting and handling of this problem in the analysis. Overall, the 26 placebo-controlled trials showed clear short-term effects of propranolol over placebo. Due to the lack of studies with long-term follow up, it is unclear whether these effects are stable after stopping propranolol. The 47 comparisons with calcium antagonists, other beta-blockers, and a variety of other drugs did not yield any clear-cut differences. Sample size was, however, insufficient in most trials to establish equivalence.

Authors' conclusions

Although many trials have relevant methodological shortcomings, there is clear evidence that propranolol is more effective than placebo in the short-term interval treatment of migraine. Evidence on long-term effects is lacking. Propranolol seems to be as effective and safe as a variety of other drugs used for migraine prophylaxis.

 

Plain language summary

Propranolol for migraine prophylaxis

Propranolol, a beta-blocker, is one of the most commonly prescribed drugs for the prevention of migraine. This systematic review identified 58 trials, and these provide evidence that propranolol reduces migraine frequency significantly more than placebo. We did not find any clear differences between propranolol and other migraine-preventing drugs, but firm conclusions cannot be drawn about the relative efficacy of propranolol and other drugs due to the small sample size of most of the trials.

 

摘要

背景

Propranolol的治療在偏頭痛的預防

Propranolol是一種最常見用來預防偏頭痛的處方用藥。

目標

我們的目的是確定是否有證據顯示propranolol用在治療偏頭痛患者比用安慰劑和其他類阻斷(預防性)藥物更為有效。

搜尋策略

透過搜索MDLINE/PubMed(1966年至2003年5月)和Cochrane Central Register of Controlled Trials (2003年，第2期)來得到一些合適的研究，並篩選綜論的目錄與確定文章。

選擇標準

我們納入了隨機和準隨機對照臨床試驗，這些試驗至少包括4周的治療時間，其間比較propranolol與安慰劑或其他藥物，在治療成人偏頭痛，有無臨床效果。

資料收集與分析

2位回顧者分別擷取資訊包括：病人、方法、干預、預後來衡量，結果使用預先測試的形式來評估。研究品質使用兩種檢查清單(Jadad scale與Delphi list)來評估。由於測量結果的異質性及報告資料的不足，只能完成選擇性的定量Meta分析。在單一試驗，盡量估計效力大小。此外，結果以統整性描訴和審稿者投票。

主要結論

一共有58個試驗與5072參與者符合納入標準。58個選定的試驗，包括26個與安慰劑比較，和47個與其他藥物比較。大部分試驗方法學的質，是不能令人滿意的。主要缺點是踢除率高和報告不足和處理這個問題的分析。整體而言，26個安慰劑對照試驗顯示，propranolol的短期影響明顯超過安慰劑。在停止propranolol後，由於缺乏長期的追蹤，目前還不清楚是否這些影響是穩定的。47個與鈣離子拮抗劑，其他β −阻斷劑，以及各種其他藥物的比較都沒有取得任何明顯的差別。然而，在大多數的試驗因為樣本不不足，而難以建立等價。

作者結論

雖然許多試驗有相關方法的缺點，然而有明確的證據表明propranolol在短期治療偏頭痛比安慰劑有效。長效的影響是缺乏的。propranolol似乎比其他各種用於預防偏頭痛的藥物有效。

翻譯人

本摘要由三軍總醫院楊登和翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

Propranolol對於具有預防偏頭痛的療效。Propranolol(一種betablocker)是一種最常見的預防偏頭痛的藥物。 這篇系統性文獻回顧找出了58個試驗，並且提供了Propranolol相較於安慰劑可以顯著地減少偏頭痛頻率的證據。我們沒有找到Propranolol與其它預防偏頭痛藥物的差異，不過由於多數試驗樣本數過小，無法作出關於propranolol及其它藥物效益有力的結論。